Student idea may box out infection during intubation

Special to Western News

A COVID box in a simulated test can help protect operating room personnel while intubating or extubating a patient with COVID-19.  Mike Ding, a first-year student in the Schulich School of Medicine & Dentistry, has worked with a large team to bring his idea to the testing stage.

A student’s idea – brought from concept to testing by a host of Western experts – has the potential to reduce exposure to COVID-19 and lead to a safer working environment for health-care professionals.

“Being a first-year Medical student, there are limited things we can do in terms of helping out,” said Mike Ding, a student in the Schulich School of Medicine & Dentistry. “I came across one of these barriers in a research paper and it intuitively made sense. If we can put enclosures over a patient, it not only helps prevent infection for physicians, it also helps alleviate a lot of the anxiety health-care workers are feeling.”

Intubation is the process of placing a breathing tube into a patient, and later removing the tube. The procedure puts health-care workers at high risk, as the process requires up-close work with an infected person, while potentially exposing those nearby to high-velocity, virus-laden droplets and aerosols.

The solution in operating rooms has been to cloak health-care professionals with as much personal protective equipment (PPE) as possible. However, Ding looked to mitigate that risk even more through an inexpensive physical barrier between patients and health-care workers.

The prototypes are reusable transparent boxes placed over the patient’s head and upper body with ‘ports’ big enough to house the health-care workers’ arms. They are currently being tested as a possible supplement to conventional personal protective equipment.

Special to Western NewsA soft-sided  ‘COVID enclosure’ – a plastic-sheathed frame made of parts readily available at hardware stores – is one of two London-developed devices being tested for use in protecting operating-room personnel from viruses during patient intubation. (submitted photo)

Designing, fabricating, consulting and testing has been a large team effort that has included Dan Sweiger and Clayton Cook of Western’s University Machine Services; Engineering professor Ryan Willing; Schulich anesthesiologist Kevin Armstong; Robarts Research Institute research associate John Moore; as well as a number of hospital clinicians in training and in medical practice.

Using Ding’s parameters, the COVID Box is a mini-fridge-sized prototype that Sweiger built out of transparent and shatterproof plexiglass with access ports to accommodate health professionals’ arms and equipment such as tubing, suction and oxygen supply.

Another prototype, the COVID Enclosure, is a soft-sided clear ‘tent’ of about the same dimensions that Moore developed with similar access ports and a frame made from PVC piping. The tenting could be discarded while the frame is re-used. “The premise was to try and make this as easy for anyone to construct. I also wanted to make it as simple as possible and easy to clean,” he said.

Both boxes are meant to provide an extra layer of safety and complement other personal protective equipment. “It doesn’t replace PPEs. It doesn’t replace N95 (masks). It’s supposed to augment them,” Armstrong said.

Before any device is approved for use in hospitals, it must undergo extensive simulations as part of the testing. In this instance, researchers had to determine if the device would be safe for patients, an effective infection barrier, and an ergonomic solution for clinicians.

In testing with simulated patients, the COVID Box and COVID Enclosure were put through their paces by 18 anesthesiologists, five anesthesiology fellows and six residence doctors. Each participant performed timed intubation simulations with no box, followed by simulations using one of the boxes.

They found no difference in the time it took to intubate. “That is what we were hoping for,” Ding said. “Those findings suggest that intubating behind a barrier does not make intubations more difficult.”

Results of the simulations have been submitted to a scientific journal for peer review and the box/enclosure aren’t in use in hospitals.

“It’s really the first step for getting these barriers into (clinical) use during COVID or for future pandemic preparedness,” Ding said.

If the devices pass muster, Ding intends to make the information and prototype dimensions publicly available for use by clinicians everywhere.

“They won’t have to start from the ground up,” he said.